Provider Demographics
NPI:1295712537
Name:MALONE, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:476 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9602
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084918207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000349348OtherANTHEM
OH000000381140OtherANTHEM
OH000963091-0009OtherPENNSYLVANIA MEDICAID
OH2162467Medicaid
OH000000028430OtherANTHEM
OH000000385522OtherANTHEM
OH000963091-0008OtherPENNSYLVANIA MEDICAID
OH000963091-0010OtherPENNSYLVANIA MEDICAID
OHP00350570OtherRAILROAD MEDICARE
OH2162467Medicaid
OHMA4193721Medicare PIN
OH000000028430OtherANTHEM
OHP00350570OtherRAILROAD MEDICARE
OHMA4193724Medicare PIN
OHMA4193723Medicare PIN